Cervical Laminectomy for Degenerative Cervical Myelopathy: Is There A Role in the Modern Day? A Systematic Review and Meta-Analysis.

Study DesignSystematic Review and Meta-Analysis.ObjectivesTo compare clinical outcomes in degenerative cervical myelopathy (DCM) patients treated with laminectomy alone (LA) vs laminectomy with fusion (LF) and determine post-laminectomy kyphosis incidence.MethodsWe searched PubMed, Scopus, Embase, Web of Science, and MEDLINE from inception-September 2024 for studies comparing LA and LF for DCM. Outcomes assessed included post-laminectomy kyphosis, neurological recovery outcomes, patient-reported outcomes (PROs), and complication rates. Meta-analyses were performed using random-effects models.ResultsTwenty-seven studies including 3286 patients (2272 LA and 1014 LF), met the inclusion criteria. The pooled incidence of post-laminectomy kyphosis in the LA patients was 2.02 events per 100 person-years (95% CI: 1.26-2.78). Post-laminectomy kyphosis declined from 3.67 cases per 100 person-years in pre-2004 studies, to 0.88 cases per 100 person-years in post-2014 studies. No significant differences were observed between LA and LF in neurologic recovery (SMD 0.29, 95% CI 0.02-0.59), pain score improvement (SMD 0.13, 95% CI: -0.38 to 0.64) and complications (OR 0.77, 95 % CI 0.29-2.08), although subgroup analysis demonstrated that the risk of complications in LA may be lower in patients with less than four operative levels.ConclusionsAlthough the annual rate of kyphosis after LA is approximately 2 events per 100 person-years, PROs and complication rates may be similar between LA and LF. These findings should be interpreted with the caveat of considerable heterogeneity between studies and further randomized trials are needed to better delineate the benefits of each approach and to optimize patient selection.

Duke Scholars

Author Courtney Rory Goodwin Neurosurgery